PSA is one of the most important biomarkers for detecting prostate cancer and guiding decisions to biopsies of the prostate. Despite its adequate sensitivity, the use of PSA testing is limited by a significant lack of specificity, which can result in unnecessary biopsies. Recent findings emphasize the limitation of these PSA threshold values to discriminate between prostate cancer and benign disease in asymptomatic men [1-3]. Therefore clinicians tried to improve a new diagnostic biomarker for clinically significant PCa. One of the most promising marker is PSA derivates such as free PSA and its ratio to total PSA (%f/t PSA).

Background: Extended pelvic lymph node dissection is the gold standard for lymph node staging in prostate cancer. Sentinel lymph node dissection has replaced extended lymphadenectomy in several tumors. The aim of the study was to stratify the rate of lymph node involvement in prostate cancer patients undergoing radio guided sentinel lymph node dissection depending on preoperative tumor characteristics.

Methods: We analyzed 2,102 prostate cancer patients (median age 67 years, IQR 62-71 years) who underwent radioisotope guided sentinel lymphadenectomy and retropubic radical prostatectomy between January 2005 and February 2015 in a retrospective single center study. Median prostate specific antigen was 7.8 ng/ml (IQR 5.5-12.7 ng/ml). 99mTechnetium nanocolloid (ca. 200 MBq) was transrectally injected into the prostate. A few hours later scintigraphy was carried out. Sentinel lymph nodes were intraoperatively detected using a gamma probe. The rate of lymph node invasion was analyzed for D’Amico risk groups and in relation to biopsy Gleason scores.

Results: The median number of lymph nodes removed was 10 (IQR 7-13). Overall, 19.3% of patients (n=405) had lymph node involvement; 2.9% (n=18) in low, 15.6% (n=139) in intermediate and 42.0% (n=248) in high risk disease. 64 (6.5%) of 984 patients with Gleason score ≤6 prostate cancer were lymph node positive; 20.6% (n=154) or 44.2% (n=84) in patients with Gleason score 7 (3+4; 4+3) and 57.5% (n=103) in Gleason score ≥8 prostate cancer.

Conclusion: We present the largest study on sentinel lymph node dissection in prostate cancer patients until now. The rate of lymph node invasion was higher in the examined sentinel collective than expected according to extended lymphadenectomy series. These results demonstrate the reliability and high sensitivity of sentinel lymphadenectomy for the detection of lymph node metastases in prostate cancer patients.

Isolated testicular Tuberculosis (TB) is a rare clinical condition. A 36-year old male patient presented to our clinic with an 8-month history of a painless mass in the right testis. No sign of tuberculosis was present and the physical examination revealed a solid mass arising from the upper pole of the right testis. The chest radiograph, urine examination, and tumor markers were normal, and lactate dehydrogenase was elevated. Scrotal ultra sonography and magnetic resonance imaging revealed a contrast-enhancing mass, 15x10 mm in size, in the upper pole of the right testis with normal epididymis and testicular blood flow. Due to the possibility of diagnosis of right testicular cancer, right inguinal partial orchiectomy was performed. The patient presented with tuberculotic granuloma with caseous necrosis in histopathological examination. The purified protein derivative test was positive (20 mm). No Acid-Resistant Bacilli (ARB) was found in culture of sputum and no tuberculosis bacilli were found in smear and culture. To date, no clinical method has been defined for the definitive diagnosis of such cases and the definitive diagnosis is only achieved by surgical exploration and histopathological examination.

I report a 40-year old pregnant woman presented with left lank pain during one month. Percutaneous left cyst aspiration was performed before 4 years ago. Complete blood count and serum biochemistry profiles were within normal limits. Additionally the patient was diagnosed with pregnant before two months. Ultrasonography revealed 18*15 cm cystic lesion in left kidney. Magnetic Resonance Imaging (MRI) showed 18x11x10 cm sized left renal cyst (Figure1). Percutaneous cyst aspiration was done for treatment. Approximately 500 ml fluid was aspirated and the pain was solved. Aspiration fluid was examined in pathology department. The result of the pathologic evaluation was benign. After three months, the patient’ complaints were started and ultrasonography imaging showed the recurrence of left renal cyst that was 12*10 cm sized.

During a Capitol Hill summit in 2013 on cancer prevention, a scientific panel discussed the link between lung, esophageal, bladder and other human cancers with smoking. A United States Senator on the panel was puzzled and asked “Why does tobacco cause bladder cancer if cigarette smoke doesn’t come in contact with the bladder? The Senator’s unfamiliarity of the role of the renal system in the metabolism of carcinogens in cigarette smoke, the subsequent exposure to the uroepithelial lining, and concentration within the bladder reflect an opportunity for the field of urology to educate not only our Elected Officials but also the general public about the link between smoking with renal, ureteral, and bladder cancer.